Thursday, March 25, 2010

Dog Bites Man, Both Survive

The sword of time will pierce our skins, it doesn't hurt when it begins. Johnny Mandel, Suicide is Painless

I'm a slower biker than I used to be. Or maybe the dogs have gotten faster. Either way, a dogs teeth "pierced my skin" last year while I was cycling a few miles north of town. I stopped, went to the owner's house and reported it. Surprisingly, he offered no apology, no help, no phone call, no nothing. He just said,"I'll take care of it." Well, that's not good enough. I told him I'd notify animal control as soon as I got home. He was not happy and made that very clear.

Actually, I pedalled out of sight of the house...and dog...stopped, cleansed the bite with everything that was in my water bottle. I tried to remove as much of the dog's saliva as possible. As soon as I was back in cell phone range, I called my wife, gave her the facts and the house
address in case the headlines in the next day's paper included "Biker shot north of town" (The dogs owner made out like it was the biker's fault) she'd know where to start the search.

Then it was a short ride to my doctors office where the wound was cleaned and disinfected, tetanus booster administered, and phone call made to animal control. Although you're concerned about infection, rabies, although unlikely, is more of a concern. I had a bat land on my head once while running - I know - a what? Although I felt the sharp claws as it landed on my skull cap, the skin wasn't broken and I wasn't bitten. They are known rabies carriers. The difference here is that with the dog, it can be observed for any signs of illness, it's inoculation status is known, as is it's physical location. None are true with the bat.

We've been vaccinating dogs in this country for over seventy years and this has reduced the documented cases of rabies to less than 5 annually. Internationally, however, upwards of 50,000 deaths occur each year, probably more. In the U.S. when we think rabies we think skunks, raccoons, foxes, and as mentioned, bats. A bat's bite can be missed, particularly by children. If one is found in the home,particularly with access to sleeping children, it should caught for later examination.

In short, although dogs chase us repeatedly, and there are some roads we avoid simply due to canine presence. Should you be bitten:

1) Identify the animal and inform local animal control
2) Cleanse the wound as best you can immediately
3) Seek medical care

As mentioned, very few die from this disease. But if you need the post-exposure rabies prophylaxis (series of shots), they are neither painless nor cheap. In other words, forget about those new aero wheels!

Saturday, March 20, 2010

Antibiotics for Triathletes - Tendon Problems?

Several athletes have questioned the use of antibiotics lately, especially as it relates to potential complications. For this piece I interviewed pharmacists at: 1) my hospital, 2) a private drug store in the area, 3) a national chain drug store, 4) The PharmD Drug Information office at a nearby large hospital, 4) The Physician's Desk Reference (very big book), etc. to try to give the most well thought out answer.

Before the discussion, however, we must continually remind ourselves that the days of simply going to the doctor with a problem and expecting to "Get something for it" are gone. Long gone. We as consumers are expected to understand that there are both viral and bacterial origins for a host of infections processes and that antibiotics are ineffective in cases of viral illness. The doctor is expected to know the difference. That said, on more than one occasion, I am quite guilty of giving out a prescription when I was certain that the patients problem was viral. It's what they expected and, particularly when working the ER, was the path of least resistance.

Depending on your source, the 5 most commonly prescribed antibiotics are Amoxicillin, Augmentin, Penicillin, Zithromycin and either Cipro or Levaquin (also known as ciprofloxacin and levofloxacin). Most of the questions have centered around the last two, members of a family of drugs called fluoroquinolones. This class of broad spectrum antibiotics has been around since WWII coming originally from a drug used in malaria called Chloroquine.

So, your physician had determined that you have a bacterial infection and needs to choose the "best" form of treatment. But the specific antibiotic chosen is a complex process taking into account the specifics of the patient and the illness, the cost of the different drugs, the insurance coverage and what out of pocket expenses will be, the dosing schedule (once a day, four times a day, etc.) and the likelihood the patient will adhere it, and...oh yeah, potential side effects. In the case of the fluoroquinolones, the potential for tendon problems is noted by the manufacturer as "Ruptures of shoulder, hand, Achilles tendon or other tendons that required surgical repair or resulted in prolonged disability have been reported.....(this risk is increased in patients taking steroids, especially the elderly.)" But simply watch any evening news TV drug ad, say for Viagra, and they quote a list as long as your arm of potential problems. I've heard that after the third one your brain shuts off. Has it stopped people from taking Viagra?

If you go to the Peoples Pharmacy web site, there are over 100 posts from folks who report a host of problems which they attribute to Levaquin. But if you look at both the significant good that these drugs do and the enormous number of prescriptions written, the incidence of tendon concerns is pretty darn low. In fact, on Slowtwitch, Dr. Rod Roof noted that "The Achilles tendon is a bit overblown (based on the number of tendon issues vs. total prescriptions that is)" and a number of physician triathlete posters have both prescribed and personally used these medications without a downside.

Triathlete take home. Print this and save it somewhere. Next time your doc recommends an antibiotic for your bacterial infection, talk to him/her about it, particularly your knowledge and concerns. And, if after reading this you feel you'd like to stay away from this class of drugs until other options have been exhausted, say so. If you do end up on one, it would seem prudent to first ensure you're not taking a corticosteroid like Prednisone, and to back off the training for a while. In the unlikely event you should experience tendon difficulties, stop the drug and call your doctor. But, again, the incidence seems pretty low and if it were me, this is the thought process I'd use and take the drug.

Monday, March 8, 2010

You Can't Arrive At The Race Site Too Early

Racking one's bike very carefully. It has a big job in just a short while.

In my mind, you're never early on race day. Maybe late, but never too early. You can't put a price on being as relaxed and in control as much as possible when the gun for your swim wave goes off.

As you get more experienced, your habits become more efficient, transition set up is more easily accomplished and you have more time to scout out the area. If you don't have the quickest transitions in your age group, WHY NOT? And who does? You can literally shave minutes from your time. In my most recent race, the shortest total transition time - T1 plus T2 - was 2:30 (guess who), and the longest 5:59. That's 3 and a half needless minutes, an eternity when checking the race results after you've crossed the line! Next week I'll blog only about transitions, but you get the point. An early arrival allows for an adequate warm up in each of the disciplines without the feeling that you're hurrying. In my mind, particularly if you are an older athlete, this is the opportunity to really loosen up the shoulders and legs. Not only does your potential for an outstanding performance increase, the probability of injury diminishes...the common thread of this web site. Not everyone agrees with this concept. In Kona, the gun for the pros is 6:45 am, and age groupers 7:00. But, if everyone looks set, the starter can release the age groupers as early as 6:55 am. Believe it or not, in what might be the most important athletic event of their lives, at 6:50 there are still people in the transition futzing around with their tires, or helmet straps, what have you. They've had months to get this done and this lack of preparedness will put them late in the water, late to the start, and perhaps spoil a major portion of the day.

I have also used this pre-race time to learn. To learn from the other participants as I appear casual in my inspection of their gear and transition area. As you might expect, those in age groups far different than mine are most eager to help. Those in my age group...less so (ahem).

Lastly, would you rather eat or work out? If you said work out, that's the right answer. You can always eat. I was recently told that French children learn from an early age that, for them anyway, meals are multi course and paced. There's even a cheese course. That's true for us on occasion, but if you can get in a 4 mile run over lunch with a 3 minute shower, or maybe even just wipes, your log book will be smiling when you get home. And don't we all like happy log books?

Sunday, March 7, 2010

Sickness/Injury Can Be a Good Thing

"Something's happening here. What it is ain't exactly clear." Buffalo Springfield

Triathletes are generally control freaks. Schedule, time, work outs, you name it and they have a very specific time and place for it in their life. One of my best tri buddies used to have such a stranglehold on his schedule that he'd leap out of bed at 2:30 a.m. to start his training day! But what happens when one is injured and forced to alter the grand plan? Or worse, when you're sick and can neither work nor work out? (Get out the Valium???)

I like to look at it as opportunity knocking. Like taking that 10 hour drive by yourself, and, when you become tired of the music, you roll along quietly, your mind drifting from topic to topic and voila, you come up with the solution to a problem that had previously escaped you.

It's at times like these when we frequently have a clearer view of options available to us, to alter habits or patterns that are less than ideal, limiters so to speak. It could be to stop smoking or perhaps realign dietary habits. Something personal and something physical. After all, we are triathletes aren't we? Sort of like a mini New Years resolution. You might think twice about pounding down that whole tube of Girl Scout cookies. (Although those thin mints are tough to put down when you've only had a couple.) I have a riding mate that used to imbibe his share - some would say more than his share - of booze, and it was during an illness where food was the last thing on his mind, that alcohol also took a back seat. He drinks very little now.

Thus, it would seem the take home lesson here is to find opportunity where others would not. Truly, you're making the best out of a bad situation.

Does this look like the swim start of the famed Ironman Triathlon World Championship in Kailua-Kona, Hawaii? It is. It's just missing a few athletes!